| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medcost
| Facility | $70.18 | $70.18 | $129.83 | |
Medcost
| Professional | $70.18 | $70.18 | $70.18 | |
Wellcare
| Facility | $112.29 | $112.29 | $171.94 | |
Wellcare
| Professional | $245.63 | $245.63 | $245.63 |